Cyber medicine enables remote neuromonitoring during aortic surgery

Abstract

This study assessed the feasibility and effectiveness of remote neuromonitoring as an adjunct to spinal cord protection during surgical repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. Four aortic centers in three European countries participated in this prospective observational study. A similar surgical protocol was used in all centers, including assessment of spinal cord function by means of monitoring motor-evoked potentials (MEPs). MEP information was evaluated at one central neurophysiologic department in Maastricht, The Netherlands. Transfer of MEP data from all operating rooms to Maastricht was arranged by Internet connections. In all patients, the protective and surgical strategies to prevent paraplegia were based on MEPs. The on-site surgeons reacted in real time to the interpretation and feedback of the neurophysiologist. Between March 2009 and May 2011, 130 patients (85 men) were treated by open surgical repair. Extent of aneurysms was equally distributed among the centers. Neuromonitoring was technically stabile and successful in all patients. The transfer of data from the operating room in the different vascular centers was undisturbed and without any technical problems. By maintaining a mean distal aortic pressure of 60 mm Hg, MEPs were undisturbed in 65 patients (50%). In another 65 patients (50%), significant changes in MEPs prompted the surgical teams to initiate additional protective and surgical strategies to restore spinal cord perfusion. These measures were not effective in five patients (3.8%), and acute paraplegia resulted. Delayed paraplegia occurred in 10 patients (7.7%) but improved in three and recovered completely in another three. No false-negative or false-positive MEP recordings were experienced. Remote neuromonitoring of spinal cord function during open repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms as a telemedicine technique is feasible and effective. It allows centralization of expertise and saves individual centers from investing in complex technology. The value of monitoring MEPs was confirmed in different aortic centers, resulting in adequate neurologic outcome after extensive aortic surgical procedures.